Mazen R Al-Mansour, MD, Robert E Merritt, MD, Kyle A Perry, MD. Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 558 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
Background: Paraesophageal hernia (PEH) following esophagectomy is an uncommon but potentially lethal complication. With increasing utilization of minimally invasive esophagectomy, the incidence of these hernias may be increasing. There is limited published data regarding the management of these hernias, and the optimal approach to their repair remains uncertain. The aim of this study was to evaluate a single institution experience with laparoscopic PEH repair in this population.
Methods: We performed a retrospective review of all patients undergoing PEH repair between 2012 and 2016 and included patients with a history of esophagectomy. The data analyzed included demographics and preoperative, perioperative and postoerative details.
Results: Five patients underwent laparoscopic repair of a symptomatic PEH following esophagectomy during the study period. All patients were male with an average age of 54 ±17 years. Mean body mass index was 21.4 ±2.6 kg/m2, and four had a history of smoking. All patients had adenocarcinoma of the distal esophagus, and 4 underwent neoadjuvant chemoradiation. The esophagectomy was performed laparoscopically in three patients and in an open fashion in two. The median interval to PEH repair was 30 (5-83) months. The most common presenting symptoms were abdominal pain (n=3), dyspnea (n=2), and nausea and/or vomiting (n=2). PEH was diagnosed in all patients by a CT scan. The herniated organs were the small bowel and colon in all patients. Four patients underwent urgent or emergent surgery due to acute hernia incarceration. The PEH repair was performed laparoscopically in all patients with an operative time of 83 ±49 minutes. Primary [RK1] crural approximation was performed using interrupted sutures. There were no mortalities in this series. Two patients developed complications: 1) an enterotomy created during hernia reduction which was identified and repaired during PEH repair, and 2) postoperative peritonitis due to a missed enterotomy that required re-exploration and small bowel resection. The median length of stay was 7 (2-21) days. The median follow-up was 4 (2-45) months[PK2] . All patients reported symptomatic improvement following hernia repair. Four patients underwent surveillance CT scan during the follow-up period, and a small asymptomatic recurrence was identified in one patient.
Conclusion: PEH following esophagectomy is a potentially serious complication that may occur following open or laparoscopic esophagectomy. Laparoscopic PEH repair is a safe, feasible, and effective treatment option for these patients that provides excellent symptomatic outcomes. Early identification of these hernias is important owing to the high risk of complications in patients presenting with incarcerated PEH.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80384
Program Number: P405
Presentation Session: Poster (Non CME)
Presentation Type: Poster